Disclaimer: I am not a veterinarian, nor do I have any formal training in any medical field. The information presented here is not meant to replace your vet's advice or prescribed medications, but only to suggest additional options to explore, based on your dog's condition.

Introduction

There are two factors that have been shown to slow progression of kidney disease and prolong life: reducing dietary phosphorus, and adding omega-3 fatty acids from fish oil (EPA and DHA). Note that reducing dietary phosphorus is not necessary and will not help before kidney disease progresses to the point where creatinine is greater than 2.0, or fasted blood phosphorus is above 4.5. Add fish oil in an amount that provides up to 50 mg EPA+DHA combined per pound of body weight daily (this maximum amount has increased from 30 mg in recent years). See my article on Fish Oil for more information.

Some commercial diets approved for adult dogs only, especially senior and light diets, contain low enough phosphorus to be fed to dogs with early stage renal disease (creatinine less than about 2.6 and fasted blood phosphorus no highter than 4.5). A few have been included below, but there is an old chart of many more included in the article Phosphorus Content in Dog Food (always be sure to verify the amount of phosphorus with the manufacturer, as it may have changed). This chart is listed in order of mg phosphorus per hundred calories, which is the best way to look at the data. Note that the numbers provided below are extracted from a number of sources and are not guaranteed to be current; it is always best to contact the manufacturer and ask for a nutritional analysis (not the guaranteed minimum) to be sure.

Not all of the foods listed below are appropriate for dogs with kidney disease, as some have changed since they were originally added. As kidney disease progresses, you might be able to combine the lower phosphorus commercial foods listed below with a prescription kidney diet to improve the overall quality of the diet. Once your dog's fasted blood phosphorus levels rise above 5.0, you will need a prescription kidney diet, as the amount of phosphorus you should feed to your dog at that point is less than AAFCO recommends.

In the table below, use the "dry matter" percentages for comparing wet and dry foods, such as canned vs. kibble. Use the "as fed" values for computing how much you are feeding. In particular, do not use the amount per can or per cup for comparison purposes, as the size of the can/cup varies quite a bit between brands. See Know the Difference: “As Fed” vs. “Dry Matter” Percentages for more information.

Remember that feeding a low protein diet is unnecessary and even harmful unless your dog is uremic, but low phosphorus is advisable. Moderate protein reduction may be required if your dog has proteinuria (significant protein in the urine). Canned food may be preferable to dry, as the extra moisture can help your dog stay hydrated, though you can add water to dry food to accomplish the same purpose.

For comparison purposes, most regular commercial diets have around 1-2% phosphorus on a dry matter basis. A dog with early stage kidney disease should be limited to no more than 0.6% phosphorus on a dry matter basis. Another way to figure it is that you want to feed no more than 30 mg phosphorus per pound of your dog's body weight daily if your dog has early stage kidney disease (less is better). These numbers must be reduced further for dogs with moderate stage kidney disease.

In addition to the high-quality foods listed in the table below, the following foods may have less than 0.6% phosphorus minimum on a dry matter basis, according to a chart I saw in a book. They're not high-quality foods but may be better choices than lower-protein diets for dogs with early-stage disease. Be sure to verify the amount of phosphorus (dry matter) with the manufacturer before feeding any of these foods:

The following foods have phosphorus amounts between 0.6% and 0.7% minimum on a dry matter basis. Again, be sure to verify the amount of phosphorus (dry matter) with the manufacturer before feeding any of these foods:

Adding fresh foods

One option to consider, particularly if your dog does not like any of the prescription kidney diets, is to feed a lower-phosphorus regular (non-prescription) commercial food such as those listed below, and then add some low-phosphorus fresh foods to reduce the overall percentage of phosphorus in the diet.

If you're feeding a high-protein commercial diet, you can add some low-phosphorus carbohydrates such as white rice, pasta, potatoes and sweet potatoes. If you are feeding a low or average protein commercial diet, you could add fatty meats that are low in phosphorus. You can add a combination of both low-phosphorus fatty meats and carbs to any kind of diet, prescription or otherwise.

For dogs with early stage kidney disease, look for foods to add in the Table of Nutritional Values with less than 100 mg of phosphorus per 100 kcals. The goal is to reduce the amount of phosphorus in the overall diet to around 100 mg per 100 kcals. Dogs with moderate or late-stage kidney disease will need foods with even less phosphorus. You cannot use non-prescription diets at all for these dogs.

Be sure to add calcium, which acts as a phosphorus binder, at the rate of 1,000 mg (1/2 teaspoon ground eggshell, or any other form of plain calcium) per pound of added fresh food.

EXAMPLE: You might provide half the dog's daily calories from a relatively low-phosphorus commercial food (less then 200 mg phosphorus per 100 kcal). The other half of the calories would come from a mixture of half fatty meat, such as 80% lean ground beef or dark meat chicken with skin, plus half low-phosphorus starchy carbs, such as white rice or sweet potatoes (the latter are more nutritious). The mixture would be based on weight, not volume; e.g., 4 oz ground beef plus 4 oz sweet potato, not half a cup of each.

Those mixtures will provide in the neighborhood of 50 calories per ounce, to help you compute how much to give. You'll have to figure out how many calories their dog needs, which you should be able to do based on whatever you've been feeding before. Such a mixture will provide in the neighborhood of 50 mg phosphorus per 100 kcal.

You must add calcium at the rate of around 1,000 mg per pound of added food. You can use ground eggshell (1/2 tsp eggshell powder provides 1,000 mg calcium), or any other form of plain calcium. Calcium helps to bind phosphorus, as well as meeting dietary needs. Dogs with kidney disease should get two to three times as much calcium as phosphorus in their diets.

The more fresh foods that are added to the diet, the more important it becomes to balance the diet in the long term (short term, a few weeks to maybe a few months, it's OK to feed an incomplete diet). This is especially true for younger dogs, who may be on the diet for years. So if half the diet is fresh foods, just fatty meat plus starchy grains won't provide all the nutrition your dog needs. Add a multi-vitamin and mineral supplement that does not include phosphorus to help make up the difference.

Dog Food Mixes

The easiest way to create a diet is by using Balance IT Canine K Plus. Unlike the regular Balance IT Canine-K, the Plus form contains no added phosphorus. I do not recommend using the regular form that does contain phosphorus.

You will need your vet's approval in order to generate recipes and purchase this supplement, but they make that easy to get. Unfortunately, the recipes generated are lower in protein than is necessary for most dogs with kidney disease, unless your dog has significant protein in the urine. The recipes are sometimes higher in omega-6 fatty acids than is advisable for dogs with kidney disease, especially if using poultry (if the nutritional analysis for "18:2 undifferentiated" is much above 100%, reduce the percentage of calories from fat or switch out the plant oil for coconut oil or olive oil when you customize the recipe). The recipes recommend using Welactin for Dogs, a fish oil supplement with 1,440 mg EPA+DHA combined per scoop (6 ml). You may want to give more fish oil than the recipes recommend (up to 30 mg EPA+DHA combined per pound of body weight daily for dogs with kidney disease).

To generate recipes, select Free AutoBalancer EZ for Vet Patients from the Homemade Food menu on the left. Next, click on Kidney Disease, then select the appropriate option for your dog using Canine K Plus. Use Customize Recipe to set your dog's weight, and also to increase the percentage of calories from Protein. You may also want to increase the amount of fat, as long as your dog doesn't have problems with too much fat. You will need to try different combinations to determine the maximum amount of protein you can request in order for the recipe to "pass." For example, the default Beef & White Rice recipe for early-stage kidney disease has 17% of calories from protein and 25% from fat. I was able to increase the percentage of protein to 22% (but no higher) while leaving the percentage of fat at 25% (higher or lower didn't affect the amount of protein I could use). The generated recipe had 526 mg phosphorus per Mcal (1,000 calories), or 52.6 mg phosphorus per 100 kcal, to compare to other foods on the chart below. Note that this amount of phosphorus is more appropriate for dogs with late-stage kidney disease then dogs with early-stage disease.

There are no longer any dog food base mixes that I know can be relied on to create a diet for dogs with early stage kidney disease. These mixes are designed to be combined with fresh foods to create a complete diet. Use higher-fat meats, tripe, whole milk ricotta cheese and combinations of whole eggs and egg whites to keep phosphorus levels reasonable, as long as your dog can tolerate a high-fat diet. Be sure to use a variety of fresh foods, not just one kind, and it's OK to feed very small amounts of foods that are higher in phosphorus, such as liver, for variety and better nutrition. Use the Table of Nutritional Values to see the amount of phosphorus per 100 kcals in various foods (far right column). Although these foods are designed to have fresh foods added, I would still add calcium at the rate of 500 mg (1/4 teaspoon ground eggshell, or any other form of plain calcium) per pound of added fresh food to help bind phosphorus.

Be sure to verify the amount of phosphorus (dry matter) with the manufacturer before feeding any of these foods:

Sojo's Original and Grain-Free (formerly European Style and Europa) -- Warning! Sojo's has replaced calcium with tricalcium phosphate in their foods. This increased the amount of phosphorus to 246 mg per 100 calories for the Original, and 260 mg per 100 calories for their Grain-Free mix, too high for dogs with kidney disease. Their complete diets are similar.

Grandma Lucy's Artisan Pre-MixWarning! The amount of phosphorus shown for all Grandma Lucy's products has increased. There is too much phosphorus in all Artisan, Pureformance, and Macanna products. Only the Valor line is low enough in phosphorus for dogs with early-stage kidney disease.

Essex Cottage Farms Kidney Diet -- ECF Kidney Diet (item 9) has approximately 0.25% phosphorus on a dry matter basis when fed as directed with just one pound of meat, according to the analysis on their web site (may not be reliable).

The Honest Kitchen Preference -- Preference has 0.99% phosphorus on a dry matter basis (254 mg phosphorus per 100 kcals), which is too high for dogs with kidney disease. Kindly is even higher..

Wendy Volhard's NDF -- I have heard one direct report of a dog with kidney failure that gained weight, lost foul breath and water consumption went back to normal on this diet (dog was fed less meat than normally called for). See K9KidneyDiet message #2103. They could not provide me with the amount of phosphorus in NDF, only figures that included added protein (80/20 raw beef, lamb or cooked chicken with skin on), which are (dry matter basis): Protein 34.7%, Phosphorus 1.3%, Calories per pound 2,172. That translates to 272 mg phosphorus per 100 kcals, which is too high for dogs with kidney disease.

Using the Table

To use the table below, pay most attention to the column on the far right, Phosphorus mg per 100 kcals. For dogs with early stage kidney disease, try to find a food (or combination of foods) with 150 mg of phosphorus or less per 100 kcals. The same is true of fresh foods you add to the diet, from the Table of Nutritional Values. Also pay attention to the next column to the left, Phosphorus (dry matter). For dogs with early stage kidney disease, you would want to feed a diet that is 0.60% or less phosphorus (dry matter). Again, you may be able to combine two different foods, one with higher phosphorus and one with lower, to get them to average out to the numbers you're looking for. You can also add fresh foods to help reduce the overall percentage of phosphorus in the diet (see above).

Note that dogs with significant proteinuria need a diet moderately reduced in protein in order to control the amount of protein in the urine, most accurately measured by urine protein:creatinine (UPC) ratio. I have not been able to determine exactly what level requires a dietary adjustment. UPC of 0.5 -0.9 is considered questionable and 1.0 is considered definitely abnormal, but glomerulonephritis is not usually diagnosed unless the UPC is 3.0 or above.

If your dog is uremic, with BUN over 80, creatinine over 4.0, and symptoms such as vomiting, nausea, inappetence and lethargy, you will have to reduce the amount of protein, but not otherwise (as long as there is not significant proteinuria), as protein only affects symptoms, it doesn't harm the kidneys (other than increasing inflammation when protein is being lost in the urine).

Be sure to verify the amount of phosphorus (dry matter) with the manufacturer before feeding any of these foods. Note that those foods shown in red below used to provide values indicating that they were low in phosphorus, but later values indicated they have much more phosphorus than shown before. There's no way to know if that's due to a change in formulation, or just inaccurate information. One of the problems with feeding non-prescription foods is that the analyses are not as reliable. Be sure to ask for an actual nutritional analysis, not just a guaranteed minimum. If the company can't or won't provide you with this information, you cannot rely on them for a special-needs diet.

Update February 2018: All foods from the following brands are too high in phosphorus for dogs with creatinine greater than 2.0 or fasted blood phosphorus greater than 4.5: Acana, California Natural, EVO, First Mate, Grandma Lucy's Artisan, Pureformance and Macanna lines (Valor is OK); Lotus (canned); Orijen; The Honest Kitchen; Sojo's; Tiki Dog; Wellness (all dry foods, including Complete Health, CORE, Simple, TruFood, and TruFood Make It Fresh; Wysong (not a complete list).

*Wysong makes high quality foods, but their Nephreon prescription kidney diet is higher in phosphorus than other prescription kidney diets, so it would only be appropriate for dogs with very early stage kidney disease whose phosphorus levels are normal (and it's questionable even then). According to the manufacturer, Nephreon is essentially Archetype with added nutraceuticals to support the kidneys. Most of Wysong's other foods are actually lower in phosphorus than either Nephreon or Archetype. See their Dry Matter Analysis of Wysong Pet Foods for percentages of all their regular foods (does not include prescription diets). Note that the canned "Au Jus" foods are just meat and organs, they are not complete diets. Of the three canned Gourmet foods, Liver is the best (lowest) and Seafood is the worst (highest) in terms of phosphorus per 100 kcals.

** You can't compare the figures for the various mixes directly to each other, as ECF figures are as fed (with water and meat added), while the rest are dry (before adding water, meat and other foods):

Essex Cottage Farm figures are as fed (mixed with meat, fish, eggs and veggies per instructions). Amounts are approximations, as they will vary depending on the fresh foods mixed in. The Kidney Diet numbers shown are for the mix combined with 1 lb of meat, 1/4 lb fish and 2 eggs to 5 cups ECF, but may not be reliable. This diet is low in protein. I would use 2 lbs meat unless your dog is uremic (BUN over 80). Note the instructions that come with the mix may be different from what is shown on the web site; do not increase the amount of fish that is added above 1/4 cup per 5 cups ECF, and do not use canned fish with bones, which are high in phosphorus. Also, do not add sunflower oil, which is high in omega-6 fatty acids that are not advisable for dogs with kidney disease. If you include poultry in the diet, there should be no need to add oils to the mix.

Honest Kitchen Preference figures are for the mix only, and do not count the meat and other foods that must be added to make this a complete diet. Keen, Love, and Zeal are complete diets that do not require other foods to be added.

Grandma Lucy's Artisan Pre-Mix figures are for the mix only, and do not count the meat and other foods that must be added to make this a complete diet. The rest of their foods are complete diets that do not require other foods to be added.

***JustFoodForDogs also offers JustDoItYourself kits for their Daily Meals (but not their Vet Support Diets), consisting of a recipe and a customized supplement blend, so you can make this food yourself at home. Customized recipes and supplement blends can also be created for a one-time fee of $195. Once created, you have the option of having the company make the food for you, or you can buy the recipe and supplement blend to make the food yourself at home. Note that the Balanced Remedy is extremely low in fat.